Portland has a proposal to fluoridate the water supply on the May ballot. I was planning to vote for it, because I understood it to have a strong preventive effect for cavities in children, and this is one of only two cities I've lived in that didn't fluoridate the water. One of the pieces of campaign literature I received says that children in Portland have 40% more cavities than children in Seattle, where the water is fluoridated.

Today I was checking to see if using household water filters removes fluoride from the water, since we were thinking of installing an inline filter in the kitchen. While I was checking, I came across two articles--linked below--that make seemingly strong arguments against fluoridation. I want to make an informed, not kneejerk or based on misinformation, decision when I cast my vote.

For reference, AIUI, the plan for fluoridation if it passes here would be a level of 0.7 PPM. I'm curious what the people of Snopes think about fluoridation and what the response is to these articles.

I wish both articles had links to sources, especially since it is so critical to control for changes in dietary and personal hygiene (esp. brushing) behavior.

I have read fluoride can be harmful in excess, but that it takes a LOT to get a harmful excess. Also, I have read that certain populations - notably the Japanese and 2 SW USA Indian tribes (Hopi and Arapaho?) - are very sensitive to fluoride and actually have teeth problems when they drink water fluoridated to the levels in most of the developed world.

The last point made in your first linked article concerns me - forced dosing of people 'for the greater good'. Fluoridation is relatively benign, AFAIK, but I am uncomfortable with setting the precedent. What's next - soma*?

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Originally Posted by Lainie

You noticed that the second link is a press release from the NYS Coalition Opposed to Fluoridation, right?

Who else is going to publish criticism of fluoridation, especially since Dr. Strangelove?

* Brave New World drug, not Soma, the back pain medication, which also should not be universally imposed, but is a different reference

The last point made in your first linked article concerns me - forced dosing of people 'for the greater good'. Fluoridation is relatively benign, AFAIK, but I am uncomfortable with setting the precedent. What's next - soma*?

A person can avoid drinking tap water, indeed many people already do and it generally has nothing to do with Fluoride.

There are a couple other examples of mass forced dosing; Vitamin D in milk, Iodine in salt to name two.

Montrealers from the 60's and 70's recall mayor Jean Drapeau and his opposition to fluoridation, being now no small part of the not-necessarily-untrue stereotype of French Canadians (in general, but specifically those from Montreal) having very bad teeth in an otherwise "first-world" country.

Mass dosing - how about enriched white flour? I admit that the "need" for this can be avoided by eating only whole-grains, but I haven't heard of any widespread opposition to it, like there is for fluoridated water. Nor for Vitamin D in milk or Iodized salt. (I'm sure the outlying groups exist, but my own "acid test" for these things is whether or not I had heard of them before the internet really became pervasive in every day life, and even "small" groups would have a "presence" that could lead to fame or more likely, "infamy". Even in the early 90's I remember hearing about fluoride as a communist plot, the moon landing being a hoax, JFK being killed by the FBI or mafia, the "flat earth society", creationists including the "young earth" variety, and so on.)

While I was checking, I came across two articles--linked below--that make seemingly strong arguments against fluoridation. I want to make an informed, not kneejerk or based on misinformation, decision when I cast my vote.

I only looked at the first one. So look at the claims they're making.

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Fluoridation of water has not been shown to reduce the incidence of cavities. Topical fluoride (e.g., toothpastes and fluoride rinses) has been shown to work. Ingestion of fluoride has not. Yes, the incidence of cavities has decreased since fluoridation has been introduced. However, the incidence of cavities has decreased even in areas without fluoridation. Yes, fluoridation has been shown to slow the eruption of teeth in children, which could have the effect of reducing cavities from bottle-feeding. However, there is also evidence that the delayed eruption is an indicator of damage incurred during tooth development. Ultimately, the link between ingestion of fluoride and reduction of cavities is tenuous at best.

Fluoride that we put in water today will still be in water tomorrow. Fluoride doesn't magically disappear from water once it has been added. Its presence and accumulation have profound implications for aquatic and terrestrial ecosystems. It is not a simple matter to remove the fluoride from water or from the plants and animals that ingest it.

That's true but fluoride is naturally occurring. That's how we figured out to add fluoride to the water. I have yet to see a valid study claiming that the additional is causing issues.

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Fluoride is poisonous. Relatively low concentrations have been shown, conclusively, to have detrimental effects on human and animal development.

So is Chlorine, Sodium, and a lot of other things. In the dose we receive from drinking water, tooth paste, and mouth wash we are fine.

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It's impossible to control the dose. People drink different amounts of water, so the fluoride dose cannot be regulated.

Just a silly statement. We add low doses to the water and it requires a large dose to cause an issue. I would have to dig for the facts but you would die from water intoxication before you died from fluoride overdose.

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It's unethical to force a medication onto people. Even if it was beneficial, fluoridation isn't something you get to choose or not choose. This is my bottom-line reason for opposing fluoridation.

It's not medication anymore then iodine or other things we add to food for health such as vitamin D or vitamin C

Of course, with the enriched white flour, the goal is just to reduce part of the good stuff that gets scoured out when you polish it. Somehow 'enriched' seemed more appealing than 'less-adulterated'.

And Dr. Dave is right that you can readily get non-iodized salt - the iodized version happens to be more popular because so many people would not get iodine from their diet.

Can you get non-vitamin-D milk? Is it added to other dairy?

As for the fluoride, to what extent do local bakeries, canneries, restaurants, etc. use fluoridated water? Or is the fluoride added only to water that goes to the residential distribution (how would they even separate that?).

What are you really worried about? Local restaurants and bakeries will undoubtedly use fluoridated water. That's part of the plan. The scare around fluoride is based on old and bad science. Wintermute is entirely correct when he says you will die of water intoxication before you will experience ill effects from fluoride. I hope this helps put tour mind at ease.
Most commercial dairy has Vitamin D. However, in some areas you can ger "raw" or unpasteurized dairy that would not have had vitamin D added. However, raw dairy poses its own set of issues.

Count me with those who say "Absolutely!" It's something I think about a lot because I grew up with it and my kids didn't. The difference is striking. The case for fluoride is based on science and the much much greater good. The case against is based on nothing but wrong information.

Actually, the case against it has some valid science. (Which as in many cases of anti-science, contributes to the myth's long life.) Fluoride does accumulate in bone, similar to how it accumulates in teeth. In teeth a small amount of fluoride increases the strength. Unfortunately, in bone that isn't the case. Fluoride collects and actually weakens the bone. Fluoride has been tried as an anti-osteoporosis medicine. Osteoporosis and tooth decay have some similarities but fluoride doesn't strengthen bone like it does teeth. Bone is constantly reformed, unlike teeth, and fluoride appears to inhibit that process resulting in weaker bones.

That being said, I know of no evidence that the level of fluoride in municipal water supplies contributes to, or reduces, the incidence of osteoporosis.

Our pediatrician prescribed chewable fluoride tablets for our kids when they were growing up because we lived in the country and had well water. Unfortunately we were living paycheck to paycheck and didn't use them regularly. Two of my kids (particularly my youngest) have a lot of cavities. This is of course anecdotal and doesn't take into account things like genetics etc. but my ped. seemed to think it was important and safe.

As I said, it is the principle of medicating people broadly. And though it is known to anyone who checks or is fairly well-read, it is fairly much 'under the radar' in the sense that there is no labeling that I know of that a consumer gets and it is not obvious from the product. I drink plenty of fluoridated water, and I have for at least 50 years (I think - I was not . I do not expect that fluoride has hurt me. The other examples given above are all products that come labeled and which one can choose whether or not to consume. Also they involve substances recognized as nutrients (other than vaccines, which I mentioned above), whereas fluoride is not, to the best of my knowledge. Fluoride seems to be, for most of us, harmless and to a certain extent beneficial for our teeth. But having established the principles of mass-dosing, what substance might be imposed next - something to make us more pliable and compliant?

Vaccines are kind of a different issue. By having broad immunization against, say, rubella, we have insured there is very little reservoir of the virus to be passed around. the vaccine-deniers point to their not catching rubella as proof the vaccines are not needed, when it is far more likely that they just never come in contact with the virus because vaccines for most of us mean there is little to contact. I fond a difference in principle when the program involved is designed to eliminate, or nearly so, the risk of potential epidemics. Infectious diseases are truly a community issue. But people do not catch cavities from each other, so that argument does not work with fluoride.

But people do not catch cavities from each other, so that argument does not work with fluoride.

Actually, ... there is evidence that bacteria contribute to cavities, indeed they may be the major cause. Hence there has been pretty significant research into a vaccine to prevent cavities. If bacteria contribute to cavities then it is likely that those bacteria are transfered from person to person.

One other point, AFAIK the level of Fluoride added to water is below the levels that occur naturally in many places. Indeed, it was the reduced incidence of cavities in places with high natural fluoride levels that led to the use of exogenous fluoride. Fluoride is a natural component of most waters. The level varies a lot but adding fluoride isn't, in my opinion, the same as adding a compound that is not normally found in water.

To explain a bit further, I grew up with fluoridation, and had the received wisdom that fluoridation is good, not harmful, and prevents cavities. I also had a knee-jerk response that the anti-fluoridation people were mostly of the "chemicals are bad!" crowd. The reason I was checking whether a water filter would remove the fluoride is that I wanted to make sure that if I installed one, we would still get the benefits of the fluoride if fluoridation happens. That's why I was a bit surprised when a person with a Ph.D. in Biomedical Science was saying the things in the first article.

The second article was another from a quick Google--I admit I didn't vet it.

This literature review seems pretty comprehensive. From the executive summary, it sounds like previous studies have mostly shown a benefit, but this review says there are few studies of good quality, and that there was a lack of appropriate analysis, and a failure to account for confounding factors even in the studies that were of high enough quality to include in the review. It still concludes that "The best available evidence suggests that fluoridation of drinking water supplies does reduce caries prevalence, both as measured by the proportion of children who are caries free and by the mean change in dmft/DMFT score."

It came to a similar conclusion about whether fluoridation of water actually provides a protective effect over and above other interventions and strategies. The studies were also of poor quality.

It seems as though fluoridation is probably beneficial, but perhaps not so definitely so as my received wisdom--and many knee-jerk responses--would have it. It's not like there haven't been lots of examples of things that everybody "knew" were good, or bad, for us, which then turned out to be the opposite when higher quality studies were done.